ABSTRACT
Gastric volvulus is a rare, potentially life-threatening
condition first described by Berti in 1866.1 A review of the
world literature in 1980 identified only 51 cases in children
under 12 years of age.2 Of these, 26 (52%) were infants and
half of these were younger than one month of age. In a recent
series, neonates have accounted for only 21% of cases of
gastric volvulus.3,4 In older children, gastric volvulus may be
associated with neurodevelopmental handicap and splenic
abnormalities but in neonates there is a strong link with
diaphragmatic defects. In the last two decades, numerous
descriptions of acute and chronic gastric volvulus in children
have been published, bringing the total number of reported
cases to more than 580.38
Gastric volvulus may be defined as an abnormal rotation of
one part of the stomach around another;9 the degree of twist
varies from 180 to 3608 and is associated with closed loop obstruction and the risk of strangulation. Lesser degrees of
gastric torsion are probably common, frequently asympto-
matic, and are not diagnostic of volvulus. Such cases may be
associated with transient vomiting in infants but spontaneous
resolution is the rule.7,10 Gastric volvulus may be either
organoaxial, occurring around an axis joining the esophageal
hiatus and the pyloroduodenal junction, or mesenteroaxial,
around an axis joining the midpoint of the greater and lesser
curves of the stomach (Fig. 46.1). The majority of patients
present with organoaxial volvulus (54%) compared to me-
senteroaxial volvulus in 41% and combined volvulus in only
approximately 2% of cases.3 A mixed or combined picture
occurs if the stomach rotates around both axes simultaneously.
The usual direction of rotation is anterior, i.e. in organoaxial
volvulus the greater curve moves upwards and forwards above
the lesser curve, causing the posterior gastric wall to face
anteriorly. The gastro-esophageal junction and the pylorus
may both become obstructed. In anterior mesenteroaxial
